Aetna provider enrollment and credentialing: a step-by-step guide

How do I get credentialed with Aetna? Provider enrollment in four steps

Aetna’s join page sets out the route:

1. Request participation. Physicians, non-physician practitioners and behavioral health professionals use the “Medical and behavioral health” form. Dentists, facilities (hospitals, other facilities and ancillary providers) and pharmacies have their own tabs.
2. Aetna weighs its network. It evaluates “the current need to service our membership in your area” and decides whether contracting, credentialing or both are required.
3. Credentialing. An NCQA-certified credentials verification organization performs all of Aetna’s credentialing and recredentialing from your CAQH ProView data (CAQH and NPI); Aetna’s FAQ adds that it holds URAC accreditation.
4. Contract and welcome materials. When credentialing is complete, the contract is finalized and Aetna sends welcome materials.

Aetna’s network FAQ orders it differently: credentialing first, then a written notice, then your network management contact completes the contract.

What do the Aetna credentialing application and forms ask for?

The Aetna provider enrollment application is the CAQH profile. Aetna’s own forms are the online request and, once you participate, its Request Changes to Provider Data Submission Form. On top of both sit participation criteria that apply to each physician and the practice for as long as the agreement lasts:

Source: Aetna, Provider and facility participation criteria (5/26) and provider manual (June 2026), read Oct 20, 2026.

Nurse practitioners meet extra criteria: a registered nurse license, at least a master’s degree in nursing, board certification and, where the state requires one, an agreement with a participating, board-certified physician that lasts the whole contract (NP and PA credentialing).

How long does Aetna provider credentialing take?

Aetna publishes no timeline for practitioners. Its one decision clock is for facilities: once the application is complete, Aetna will “make a decision within 60 days.” Everything else it publishes is a deadline, most of them yours:

Other plans do publish a figure: Cigna’s is 45 to 60 days (Cigna and Evernorth), and our credentialing overview lines up the figures the major plans publish.

How do behavioral health providers join the Aetna network?

Through the same “Medical and behavioral health” request: Aetna Behavioral Health is “an internal business unit of Aetna,” not a separate company with its own application. Its criteria add:

• Appointments: emergency or urgent care seen immediately (or referred to an emergency room, urgent care or crisis center); symptomatic, non-urgent care within 7 business days; a routine first visit within 10 business days; follow-ups within 3 weeks for non-prescribers and 5 weeks for prescribers. Stricter state rules win.
• After hours: a voicemail or live answering service 24/7, with a greeting that sends callers to the nearest emergency department, to 911 or 988 in a crisis, or to a licensed behavioral health professional available around the clock.
• Groups: every provider must meet the criteria and “agree to participate in all plans covered under the group agreement.”
• Prescribers: an unrestricted right to prescribe, to the full extent state law allows in the specialty.
• ABA practices: extra criteria, among them one hour of face-to-face supervision by a BCBA or a licensed behavioral health professional for every 10 hours a paraprofessional delivers (ABA credentialing).

License by license, from Medicare to the other behavioral networks: mental health credentialing and our page for therapy practices.

How do I set up Aetna ERA enrollment and EFT?

• EFT. Aetna’s manual sends you from Aetna.com to Availity, where you enroll and make changes. Without EFT, Aetna may pay by virtual credit card: an explanation of payment with a one-time 16-digit card number, by fax or mail, that you key into your card terminal. Aetna charges no fee for it, but your usual merchant fees apply, and leaving virtual cards means enrolling in EFT first and processing any card payments still open.
• ERA. You need software that can post the remittance and a vendor to receive the files; one tax ID can get separate ERAs for each billing address and NPI. With both, the ERA file and the EFT carry the same trace number, and without ERA that number pulls the explanation of benefits from Aetna’s provider portal.

How do I keep my Aetna credentialing current?

Recredentialing every 3 years, “unless otherwise required by state regulations, federal regulations or accrediting agency standards.” Aetna works from the same CAQH profile, which has to be re-attested every 120 days (recredentialing).

Directory information every 90 days. Aetna’s manual says the law requires you and Aetna to confirm it at least that often, and Aetna can ask at any time. Update it in Availity, or with the Request Changes form if you can’t use Availity; a missed change brings “corrective action” under your agreement. The federal text behind it, for group health plans and insurers:

“…not less frequently than once every 90 days, such plan or such issuer (as applicable) verifies and updates the provider directory information…”

Medicare Advantage, quarterly and within 7 days. Validate your demographics each quarter when Availity prompts you, and report a move or a new phone number or email in Availity’s Provider Data Maintenance within seven days, without waiting for the quarter and without calling or faxing Aetna. Aetna can act against a provider who refuses, up to ending Medicare Advantage participation. Those plans had 265,065 Florida members in October 2026, 8.7% of the state’s 3,058,968 Medicare Advantage and PACE enrollees, 13,079 of them in Miami-Dade.

What you can do today

1. Check each clinician against the table above before anyone files, with Aetna’s participation criteria open: board certification, admitting privileges or a coverage arrangement, and malpractice that meets your state’s rule.
2. Re-attest each CAQH profile that is close to its due date, and designate Aetna as an authorized health plan in it.
3. File one request per clinician on Aetna’s join page, under “Medical and behavioral health”.
4. Watch for the CAQH kit a clinician new to CAQH should get; if it hasn’t come in 10 business days, call Aetna credentialing at 1-800-353-1232.
5. Get someone in the office into Availity. EFT enrollment, directory confirmations and Medicare Advantage attestations all run there.
6. Put the recurring dates on one calendar: the 90-day directory confirmation, the 120-day CAQH re-attestation, the 3-year recredentialing and the 30-day malpractice notice.

Advixor’s payer enrollment service covers the preparation, submission, monitoring and follow-up of each credentialing and enrollment application.